About Fall Creek Rehabilitation and Healthcare Center
Fall Creek Rehabilitation And Healthcare Center, located in Humble, TX, is a for-profit organization that accepts Medicare and Medicaid.
Why Families Choose Fall Creek Rehabilitation and Healthcare Center
Key Performance Indicators
- CMS Overall Rating 1 Stars
- Nursing Hours 3.18 hrs
- Safety Record Clean
Chain Affiliations & Network
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Nursing Staff Analysis
Staffing levels are a critical indicator of quality care. We analyze the daily hours of care provided by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs).
Below Average Staffing
Fall Creek Rehabilitation and Healthcare Center provides less care hours than the state average and less than the national average.
Registered Nurses (RN)
Licensed Practical Nurses
Certified Assistants
CMS Quality Ratings
| Category | Rating | Stars |
|---|---|---|
| Overall Rating | 1 |
|
| Health Inspection | 2 |
|
| Quality Measures | 3 |
|
| Staffing | 1 |
|
Health Inspection History
| Inspection Cycle | Score | Date |
|---|---|---|
| Cycle 1 (Most Recent) | 28 | May 30, 2025 |
| Weighted Average | 129 | Combined Score |
Detailed Quality Measures
Rates are from CMS quality measures (claims-based and MDS-based) for the reporting period ending May 01, 2026. Some measures may be omitted when CMS does not report a numeric rate for this facility.
Medicare claims-based measures
Typically includes short-stay outcomes, hospitalizations, and ED use from Medicare claims.
| Measure | Rate |
|---|---|
| Percentage of short-stay residents who were rehospitalized after a nursi... (QM521) | 27.4% |
| Percentage of short-stay residents who had an outpatient emergency depar... (QM522) | 13.0% |
| Number of hospitalizations per 1000 long-stay resident days (QM551) | 3.6% |
| Number of outpatient emergency department visits per 1000 long-stay resi... (QM552) | 2.8% |
MDS-based measures
Resident assessment data; often used for long-stay care quality.
| Measure | Rate |
|---|---|
| Percentage of long-stay residents whose need for help with daily activit... (QM401) | 21.1% |
| Percentage of long-stay residents who lose too much weight (QM404) | 3.6% |
| Percentage of long-stay residents with a catheter inserted and left in t... (QM406) | 0.0% |
| Percentage of long-stay residents with a urinary tract infection (QM407) | 0.0% |
| Percentage of long-stay residents who have depressive symptoms (QM408) | 0.0% |
| Percentage of long-stay residents who were physically restrained (QM409) | 0.0% |
| Percentage of long-stay residents experiencing one or more falls with ma... (QM410) | 6.3% |
| Percentage of long-stay residents assessed and appropriately given the p... (QM415) | 99.2% |
| Percentage of short-stay residents assessed and appropriately given the... (QM430) | 95.5% |
| Percentage of short-stay residents who newly received an antipsychotic m... (QM434) | 0.7% |
| Percentage of long-stay residents whose ability to walk independently wo... (QM451) | 23.6% |
| Percentage of long-stay residents who received an antianxiety or hypnoti... (QM452) | 6.1% |
| Percentage of long-stay residents assessed and appropriately given the s... (QM454) | 96.9% |
| Percentage of short-stay residents who were assessed and appropriately g... (QM472) | 93.5% |
| Percentage of long-stay residents with pressure ulcers (QM479) | 11.0% |
| Percentage of long-stay residents with new or worsened bowel or bladder... (QM480) | 9.5% |
| Percentage of long-stay residents who received an antipsychotic medicati... (QM481) | 2.7% |
Complaints & Deficiencies
Complaint History by Year
This chart shows the number of complaints filed each year.
Summary:
- 2023: 2 complaints
- 2024: 3 complaints
- 2025: 8 complaints
- Total: 13 complaints on record
Recent Complaints (Since Jan 2023)
| Date | Description |
|---|---|
| Jul 14, 2025 | Provide and implement an infection prevention and control program. |
| Jun 02, 2025 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. |
| Jun 02, 2025 | Provide care and assistance to perform activities of daily living for any resident who is unable. |
| Apr 14, 2025 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. |
| Apr 14, 2025 | Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. |
| Apr 14, 2025 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. |
| Feb 06, 2025 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. |
| Feb 06, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| Apr 03, 2024 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. |
| Apr 03, 2024 | Provide enough food/fluids to maintain a resident's health. |
| Feb 15, 2024 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. |
| Nov 21, 2023 | Protect each resident from the wrongful use of the resident's belongings or money. |
| Nov 21, 2023 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. |
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Owner & Operator Information
Business Entity
LTC OF FALL CREEK LLC
Ownership Structure
- BULLPEN FAMILY VENTURE LP Indirect
- BULLPEN ONE LLC Direct: 10%
- EDAWS INVESTMENT GROUP LP Direct: 90%
- MICHAEL REED Indirect
- STACIE REED Indirect
- FORREST THREADGILL Indirect
- MORGAN THREADGILL Indirect
- SHARLYN THREADGILL Indirect
Management & Direction
- CLEARLAKE HEALTHCARE REALTY LLC ADP OF THE SNF
- CHARLES COMPTON ADP OF THE SNF
- JAMES COMPTON ADP OF THE SNF
- KRIS COMPTON ADP OF THE SNF
- COMPTON3 HOLDINGS LLC ADP OF THE SNF
- JULIA LANIER ADP OF THE SNF
- MARTEL HEALTHCARE MANAGEMENT LLC ADP OF THE SNF
- MICHAEL MARTEL ADP OF THE SNF
- JEFFREY SMITHERS INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
- RACHEL SUTER OPERATIONAL/MANAGERIAL CONTROL
- RACHEL SUTER ADP OF THE SNF
- THE SMITHERS MANAGEMENT TRUST ADP OF THE SNF
- SHARLYN THREADGILL OPERATIONAL/MANAGERIAL CONTROL
Associated Doctors
Local Comparison
| Facility | Distance | Rating |
|---|---|---|
| The Methodist Hospital Snf | N/A | 5 |
| Park Manor of Cyfair | N/A | 5 |
| Bayou Manor | N/A | 5 |
| The Vosswood Nursing Center | N/A | 4 |
| The Village at Gleannloch Farms | N/A | 5 |
| East View Healthcare | N/A | 5 |
| The Hallmark | N/A | 5 |
| Houston Transitional Care | N/A | 5 |
| Park Manor of Conroe | N/A | 5 |
| Lawrence Street Health Care Center | N/A | 4 |
Related Analysis
Best Nursing Homes in Humble, TX
Compare Fall Creek Rehabilitation and Healthcare Center to the top-rated facilities in the area.
Ownership Details
Complete list of registered owners, including direct and indirect ownership.
Noted Deficiencies
Detailed history of deficiencies with descriptions and correction dates.
Nursing Hours Analysis
Detailed breakdown of staffing hours per resident by role.
Frequently Asked Questions
- Skilled Nursing Care: 24/7 medical supervision and complex medical treatments
- Long-term Residential Care: Assistance with daily living activities for extended stays
- Short-term Rehabilitation: Recovery services after hospital stays or surgeries
- Memory Care: Specialized programs for residents with dementia and Alzheimer's disease
- Level of care needed (skilled nursing vs. long-term care)
- Room type (private vs. semi-private)
- Insurance coverage (Medicare, Medicaid, private insurance)
- Length of stay and specific services required
For current rates and to discuss payment options, contact Fall Creek Rehabilitation and Healthcare Center directly at 2819024152. Their admissions team can help determine coverage and out-of-pocket expenses.
Environment & Cleanliness
- Overall cleanliness and odors
- Resident room conditions
- Common area maintenance
- Safety features and accessibility
Staff & Care Quality
- Staff-to-resident ratios
- How staff interact with residents
- Response time to resident needs
- Staff knowledge and professionalism
Ask to speak with current residents and their families, tour at different times of day, and review the facility's most recent inspection reports.